Abstract 13047: A Novel Fiberoptic Scope to Interrogate the Pericardial Cavity and Perform Epimyocardial Injections of Stem Cells Under Visual Guidance
Rationale: Stem cell therapy may represent a new avenue in the treatment of ischemic heart disease and has been shown promising results in preclinical studies and phase IIA/B clinical trials. Intramyocardial injection has been proposed as the preferred method of cell administration in patients with chronic ischemic disease, rather than by intracoronary infusion, due to the devastated state of the coronary tree in end stage coronary artery disease. However, percutaneous intramyocardial injection is generally a laborious procedure and results in a mere 10-20% myocardial retention of the injected cell suspension. Here we studied a fiberoptic scope (OlympusTM) to facilitate direct epimyocardial injection of stem cells under visual guidance in healthy and post-AMI pigs.
Methods and Results: 10 swine were used in the current study (2 naïve vs. 8 AMI pigs). Intrapericardial interrogation and intramyocardial injection using the transpericardial endoscope was well tolerated, even in animals previously subjected to a large LAD infarct. It enabled the direct visualization of the pericardial cavity and direct intramyocardial injection of cells under visual guidance, resulting reproducibly in complete cell retention in a limited time frame (visually successful injection frequency: 66 %; mean injection time: 3.6 min per targeted injection). Moreover, narrow band imaging based on oxymetry visualization, allowed the distinction between perfused myocardial tissue and hypoperfused infarct scar, and therefore facilitated targeted injection into the border zone of the infarct. All of the animals that were interrogated by the pericardioscopy survived until sacrifice at day 7, and showed no signs of pericardial infection or effusion. Histological analysis showed local deposition of the cells, without signs of physical damage or inflammation. We will present the results of our full cohort of 15 animals during the scientific sessions of the AHA 2012.
Conclusion: Analysis and injection under visual guidance by the pericardioscopy was well tolerated in swine even with a compromised myocardial function. We report the first experience of intramyocardial injection of stem cells under direct visual guidance using an intrapericardial fiberoptic scope.
- © 2012 by American Heart Association, Inc.